title: Six-month outcomes following an emergency hospital admission for older adults with co-morbid mental health problems indicate complexity of care needs.
abstract: BACKGROUND
  two-thirds of older patients admitted as an emergency to a general hospital have co-existing mental health problems including delirium, dementia and depression. This study describes the outcomes of older adults with co-morbid mental health problems after an acute hospital admission.
  
  
  METHODS
  a follow-up study of 250 patients aged over 70 admitted to 1 of 12 wards (geriatric, medical or orthopaedic) of an English acute general hospital with a co-morbid mental health problem and followed up at 180 days.
  
  
  RESULTS
  twenty-seven per cent did not return to their original place of residence after the hospital admission. After 180 days 31% had died, 42% had been readmitted and 24% of community residents had moved to a care home. Only 31% survived without being readmitted or moving to a care home. However, 16% spent >170 of the 180 days at home. Significant predictors for poor outcomes were co-morbidity, nutrition, cognitive function, reduction in activities of daily living ability prior to admission, behavioural and psychiatric problems and depression. Only 42% of survivors recovered to their pre-acute illness level of function. Clinically significant behavioural and psychiatric symptoms were present at follow-up in 71% of survivors with baseline cognitive impairment, and new symptoms developed frequently in this group.
  
  
  CONCLUSIONS
  the variable, but often adverse, outcomes in this group implies a wide range of health and social care needs. Community and acute services to meet these needs should be anticipated and provided for.
authors.affiliation: Division of Rehabilitation and Ageing, University of Nottingham, Nottingham NG7 2UH, UK.
authors.forename: Lucy E
authors.initials: LE
authors.lastname: Bradshaw
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Goldberg
authors.forename: Sarah A
authors.initials: SA
authors.lastname: Lewis
authors.forename: Kathy
authors.initials: K
authors.lastname: Whittamore
authors.forename: John R F
authors.initials: JR
authors.lastname: Gladman
authors.forename: Rob G
authors.initials: RG
authors.lastname: Jones
authors.forename: Rowan H
authors.initials: RH
authors.lastname: Harwood
mesh_terms: D000203:Activities of Daily Living; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000523:psychology*; D003071:Cognition; D015897:Comorbidity; D019033:Delivery of Health Care, Integrated; D004636:Emergency Service, Hospital; D004739:England / Q000453:epidemiology; D005260:Female; D006707:Homes for the Aged; D006769:Hospitals, General; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology / Q000401:mortality / Q000523:psychology* / Q000628:therapy; D008603:Mental Health; D009735:Nursing Homes; D010343:Patient Admission; D010351:Patient Discharge; D010359:Patient Readmission; D011379:Prognosis; D012307:Risk Factors; D017741:Survivors / Q000523:psychology*; D013997:Time Factors
keywords: general hospital; mental health; older people; outcome